Depression Treatment Flashcards
What type of family of antidepressants are clomipramine, imipramine, desipramine, amitriptyline, nortriptyline and protriptyline? [1]
TRICYCLIC ANTIDEPRESSANTS (TCAs)
Describe the MoA of TCAs [2]
- Inhibit reuptake of amines on the presynaptic terminal, so 5HT or NA cannot be taken back into neuron
Apart from inhibiting the reuptake of amines, which other receptors do TCAs bind to? [3]
Why is this problematic? [1]
Bind to:
* H1 receptors
* muscarinic receptors
* α1 and α2 adrenoceptors
Causes wide ranging side effects
Look up which TCAs need to know
Important AEs of TCAs? [4]
- Dangerous (cardiotoxic) in overdose
- Anti-cholinergic: dry mouth; blurred vision, constipation, urinary retention, aggravation of narrow angle glaucoma, fatigue, postural hypotension, dizziness, loss of libido, arrhythmias
- Antihistaminic: sedation, weight gain.
- Block alpha 1 adrenoreceptors: orthostatic hypotension - blood pressure drops on standing, cardiac effects
As a result aren’t the first choice!
Phenelzine, tranylcypromine belong to which drug class? [1]
MONOAMINE OXIDASE INHIBITORS
Describe the MoA of monoamine oxidase inhibitors such Phenelzine, tranylcypromine [1]
Which type of food interact with MOIs? [1]
Irreversible inhibition of the enzyme monoamine oxidase [1]
Interactions with tyramine-containing food (mature cheese, pickled fish and meat, red wine, beer, broad bean pods, yeast extract)- restrictions continue at least 2 weeks after discontinuation
Why do you have to wait approx. 2 weeks if you want to change treatment away from MAOIs? [1]
The drugs bind irreversibly: wait for at least 50% of enzymes have been replaced to change treatment
What type of drug class are citalopram, fluoxetine, paroxetine sertraline? [1]
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
What is the benefit of using SSRIs (citalopram, fluoxetine, paroxetine) with regards to AEs [3]
No anticholinergic activity
No cardiotoxic effects
Safe in overdose
Which is the most selective SSRI?
citalopram
sertraline
fluoxetine
paroxetine
Which is the most selective SSRI?
citalopram
sertraline
fluoxetine
paroxetine
AEs of SSRIs?
· Nausea vomiting
· Dry mouth
· Headache
· Asthenia
· Dizziness
· Anorexia
· Weight loss
· Nervousness
· Tremor
· Convulsions
· Sexual dysfunction
Moclobemide belongs to which drug class? [1]
REVERSIBLE MONOAMINE OXIDASE INHIBITOR
What are the different targets for reverible MAOIs compared to irreversible MOAIs? [2]
Describe the benefits of reversible MAOIs compared to irreversible MAOs [2]
Drug targets:
* Reversible MAOI targets: MOA-A
* Irreversible MAOI targets: MAOA versus MAOB
Differences:
* Reversible is safer than irreversible MAOIs
* Can switch drug classes quicker
Which is the safest monoamine oxidisase inhibitor?
Moclobemide
Phenelzine
Tranylcypromine
Which is the safest monoamine oxidisase inhibitor?
Moclobemide (reversible MOAIs)
Phenelzine (irreversible MOAIs)
Tranylcypromine (irreversible MOAIs)
Describe MoA of Agomelatine [2]
Why is this potentially a really good drug? [2]
MoA:
* Agonist at melatonin MT1 & MT2 receptors: important for sleep control
* Antagonist of 5-HT2 receptors
Benefits of Agomelatine:
* improves sleep quality
* less sexual dysfunction than SSRIs;
* anxiolytic effects
* no ‘discontinuation syndrome’
The treatment with the SNRI [] reduces the increased Default Mode Network
connectivity seen in depression
The treatment with the SNRI duloxetine reduces the increased Default Mode Network connectivity seen in depression
How long do antidepressant drugs take to cause action in the body?
Although the level of drug increases in plasma soon after the patient starts taking the medication, there is a delayed onset of action of 1-2 weeks
Explain why there is a delayed action for anti-depressant drug action for TCAs [4]
The immediate increase in synaptic concentration of amines
may lead to activation of somatic neuronal autoreceptors
The activated autoreceptors decrease firing of the neurones
During the first weeks of treatment the autoreceptors desensitize
The neurones will return subsequently to the normal firing rate
The inhibition of reuptake continues and the level of amines
continues to be high, resulting in full efficacy
Depression drugs
Name a noradrenaline reuptake inhibitor used for depression treatment [1]
Reboxetine
Depression Drugs
Name a serotonergic antagonist and reuptake inhibito (SARI) [1]
Trazodone
Depression drugs
Name a noradrenergic and specific serotonergic antidepressant (NaSSA) [1]
Mirtazapine
What changes to drug treatment may trigger antidepressant drug discontinuation syndrome? [3]
What are the symptoms?
A condition that can occur after:
- a decrease in the dose of drug taken
- an interruption of treatment
- abrupt cessation of treatment
Insomnia
Anxiety
Nausea
Headaches
Electric shock sensations
Agitation
Mood swings
Diarrhoea/abdominal cramps
What drug do you give to manage bipolar disorder? [1]
What needs to be considered about this when adminsitering? [1]
Lithium
Narrow therapeutic margin
Which organs need to be monitored when giving lithium for bipolar disorder? [2]
Renal and thyroid function must be checked before treatment (and then at regular intervals during maintenance treatment)
Apart from lithium, name two other drugs used as mood stabilisers [2]
Carbamazepine, sodium valproate
Name two risks of using antidepressant drugs used in bipolar disorder to treat periods of depression? [2]
can precipitate manic episodes or mixed
affective states
induce an increased frequency
in mood change cycles
Explain the three phases of antidepressant treatment [3]
Acute Treatment
- First 6-12 weeks of treatment; aims at remission (control of symptoms)
- Inadequate early response is associated with poor prognosis
Continuation Treatment
- for 6 months after full symptom control; to maintain remission status and prevent relapse
Maintenance Treatment
- Aims at prevention of recurrence of a further episode of depression.
- Indicated when higher risk of these recurrence; “maintenance dose”.
Name 4 non-pharmacological approaches for mood disorders
Electroconvulsive therapy (treatment-refractory severe depression with suicide risk)
Cognitive behavioural therapy (CBT) (can augment the effects of pharmacological treatment)
Vagal nerve stimulation (especially in chronic depression)
Deep brain stimulation (DBS); subcallosal cingulate white matter – Brodmann area 25)
Which area is the DBS target for treating depression? [1]
What the is the Broadmann area?
21
22
23
24
25
Which area is the DBS target for treating depression: subgenual cingulate cortex
What the is the Broadmann area?
21
22
23
24
25
Name two new therapeutic developments for depression [2]
What types of depression do they speficifically treat? [2]
What are their MoAs? [2]
Esketamine:
* NMDA glutamate receptor antagonist
* treatment-resistant depression
Brexanolone:
* progesterone-related compound, positive modulator of GABAA receptors
* approved for post-partum depression
Ketamine blocks NMDA glutamate receptors on GABA neurons.
Which receptors does this have an effect on and what is this response? [2]
Enhances transmission at the glutamatergic synapse: enhances signaling through AMPA glutamate receptors and also increases the level of brain-derived neurotrophic factor, BDNF
Which drug class has the highest risk for mania if used to treat depression in bipolar patients?
TCAs
SNRIs
MAOIs
SSRIs
Which drug class has the highest risk for mania if used to treat depression in bipolar patients?
TCAs
SNRIs
MAOIs
SSRIs
Which is the first line drug choice for treating depression
TCAs
SNRIs
MAOIs
SSRIs
Which is the first line drug choice for treating depression
TCAs
SNRIs
MAOIs
SSRIs
Which class of drugs can you not use / creates lots of AEs if they eat food like red wine, cheese or mature cheese?
TCAs
SNRIs
MAOIs
SSRIs
Which class of drugs can you not use / creates lots of AEs if they eat food like red wine, cheese or mature cheese?
TCAs
SNRIs
MAOIs
SSRIs
Which of the following is a reversible MAOI?
phenelzine
moclobemide
tranylcypromine
agomelatine
Which of the following is a reversible MAOI?
phenelzine
moclobemide
tranylcypromine
agomelatine
Which of the following has the quickest onset?
TCAs
SNRIs
MAOIs
SSRIs
Which of the following has the quickest onset?
TCAs
SNRIs : duloxetine and venlafaxine
MAOIs
SSRIs
Which of the following drug class cause discontinuation syndrome
TCAs
SNRIs
MAOIs
SSRIs
Which of the following drug class cause discontinuation syndrome
TCAs
SNRIs
MAOIs
SSRIs
Which of the following is noradrenaline reuptake inhibitor?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following is noradrenaline reuptake inhibitor?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following is noradrenergic and specific serotonergic antidepressants (NaSSA)?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following is noradrenergic and specific serotonergic antidepressants?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following is a serotonergic antagonist and reuptake inhibito (SARI)?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following is a serotonergic antagonist and reuptake inhibito (SARI)?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following reduces the increased default mode network connectivity seen in depression?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following reduces the increased default mode network connectivity seen in depression?
Duloxetine
Reboxetine
Mirtazapine
Tianeptine
Trazodone
Which of the following would be used to treat treatment resistant depression
Duloxetine
Esketamine
Mirtazapine
Brexanalone
Trazodone
Which of the following would be used to treat treatment resistant depression
Duloxetine
Esketamine
Mirtazapine
Brexanalone
Trazodone
Which of the following would be used to treat post-partum depression
Duloxetine
Esketamine
Mirtazapine
Brexanalone
Trazodone
Which of the following would be used to treat post-partum depression
Duloxetine
Esketamine
Mirtazapine
Brexanalone
Trazodone
Which of the following class of drug causes this symptom?
TCAs
SNRIs
MAOIs
SSRIs
(orthostatic hypotension)
Which of the following class of drug causes this symptom?
TCAs: due to blocking of Block alpha 1 adrenoreceptors
SNRIs
MAOIs
SSRIs
TCAs are toxic to which part of the body? [1]
Cardiotoxic: Blockade of fast sodium channels in myocardial cells slows the action potential and provides a membrane stabilizing effect. The characteristic QRS prolongation seen in TCA overdose occurs secondary to prolongation of phase “0” of the myocardial action potential. T
Which of the following is the most cardiotoxic?
Amitriptyline
Nortriptyline
Citalopram
Sertraline
Fluoxetine
Which of the following is the most cardiotoxic?
Amitriptyline
Nortriptyline
Citalopram
Sertraline
Fluoxetine
Most common AE of SSRI? [3]
gastrointestinal symptoms are the most common side-effect:
